HDFC ERGO Health Suraksha Gold Policy

HDFC Ergo Health Suraksha Gold Plan Overview

Life is highly unpredictable and full of uncertainties that is why one should stay guarded with an appropriate medical insurance policy. These days hospitalization is very expensive and it can easily make a hole in your pocket. Hospitalization can be both financially and emotionally stressful. Therefore, it is wise to buy a health insurance policy that covers the maximum ailments.

Hospitalization expenses that were incurred immediately 60 prior to the hospitalization

Hospitalization expenses that were incurred immediately 90 days after the hospitalization

144 listed daycare treatments/surgeries where 24-hours of hospitalization is not essential

Domiciliary treatment cost that would otherwise have required hospitalization on the recommendation of the doctor, if the policyholder could not be moved to a hospital or if there is no hospital bed available

Organ donor transplantation expenses incurred on harvesting the donated organ up to the sum insured amount

Emergency ambulance up to Rs. 2,000 for sum insured of Rs. 3 lakhs, 4 lakhs, and 5 lakhs. And for sum insured up to Rs.3500 for Sum Insured of Rs. 7.5 lakhs and 10 lakhs

Newborn baby cover in patient medical expenses within 90 days of birth

Maternity benefits after completion of 4 years

Expenses related to Normal Delivery expenses up to Rs. 15,000 & Rs. 25,000 for LSCS and for termination the limit is Rs. 15,000

Pre and post natal expenses up to Rs. 1,500

New Born cover up to Rs2,000

Cumulative Bonus: 5% to 50% of the Basic Sum Insured for every claim free year. If a claim is filed, the cumulative bonus will get reduced by 5% of the basic sum insured.

Critical Illness E-Opinion: In case of diagnosis of critical illness during the policy term you can take a second opinion from an empaneled doctor. It requires proper information, documentation and the doctor will give the second opinion directly to the insured person.

Convalescence benefit in case the hospitalization lasts for more than 10 consecutive days. The insurer will pay off in a lump sum up to 10,000 rupees and up to a maximum 1 percent of the Sum Insured.

Exclusions of HDFC Ergo Health Suraksha Gold Plan

Any hospitalization required within 30 days of the policy commencement date except for accidental injuries

2-years of a waiting period for tonsil surgery, cysts, sinuses, internal tumor, etc.

Pre-existing illnesses are recompenses after 48 months of the continuous policy term

Expenses incurred on treatment related to AIDS and HIV

Mental disorders, weight loss treatment, and cosmetic surgeries

Health issues arising after an overdose of alcohol and drugs

Hospitalization required due to war, nuclear elements, radiations, and weapons

Pregnancy complications unless specifically cover

Dental care and external appliances unless included in the plan

Terrorist activities, war, and radioactivity

HDFC ERGO Health Insurance Claim Procedure

You can seek reimbursement of your medical expenses or avail cashless hospitalization in this plan-

Reimbursement Claim Procedure

You can file reimbursement of your hospitalization expenses for a treatment taken in a non-network hospital. To avail the benefits you need to notify the insurer and the procedures is listed below:

For hospitalization in a non-network hospital, initially, the payment needs to be made from your own pocket. The reimbursements need to be filed within 7 days of getting discharged from the hospital

All the medical bills will be compensated after discharge, provided all the documents are submitted with the claim form

After verification, your claim request will be approved, and the insurance company will settle the amount within 30 days of document submission

When there is a medical emergency, the insurance company needs to be informed within 24 hours of hospital admission. For planned hospitalizations, you should notify the insurance company within 48 hours of getting hospitalized

Cashless Claim Procedure

All the treatments that are taken in a network hospital are eligible for cashless claims. To start with the treatment, you would need authorization from the insurance company based on the procedures listed down in the medical insurance form.

The process is listed below-

For planned hospitalizations, you should inform the insurance company within 48 to 72 hours before starting the treatment in a panel hospital

In the event of an unplanned hospitalization, you need to inform the insurance provider after admission

Furnish your health card and a photo identity card

Once the verification is completed, you will need to submit the duly filled pre-authorization form to the TPA or the claim settlement team.

Upon verification of the pre-authorization request form, the insurance company will give approval before the cashless treatment starts

Documents Required for Claim Registration

Duly signed and filled claim form with the policy number

Discharge summary

Investigation reports (e.g. X-Ray, blood reports, etc.)

Final bill with payment receipts, detailed breakup and, original medicine bills with prescriptions

Implant invoice for example lens in cataract surgery, a stent in angioplasty, etc.

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